Late Recurrence of Anisometropic Amblyopia.

A 15-year-old boy whose anisometropic amblyopia was effectively treated with glasses was examined. Despite years of stability, his visual acuity decreased from 20/20 to 20/60 with poor glasses compliance. Although amblyopia recurrence is well recognized, this case emphasizes potential late recurrence after prolonged success. Fortunately, he improved to 20/20 after improved compliance. [J Pediatr Ophthalmol Strabismus. 2024;61(1):e11-e12.].

Anisometropic amblyopia: A review of functional and structural changes and treatment.

Amblyopia is the decreased best-corrected visual acuity (BCVA) in one or both eyes caused by the abnormal processing of visual input during development. One common cause of amblyopia is anisometropia, which has attracted widespread attention. Many structural changes occur in the primary and extrastriate visual areas of the cerebral cortex, as well as in the eyes, in patients with anisometropic amblyopia. Understanding these mechanisms has provided a favorable theoretical basis for treating anisometropic amblyopia. This article reviews the functional and anatomical changes and progress toward the treatment of anisometropic amblyopia.

[Changes in accommodation in children with hyperopic anisometropia and unilateral amblyopia after laser refractive surgery and pleoptic treatment]. / Izmenenie akkomodatsii u detei s gipermetropicheskoi anizometropiei i odnostoronnei ambliopiei posle refraktsionno-lazernoi operatsii i pleopticheskogo lecheniya.

PURPOSE: This study comparatively analyzes the state of accommodation in children with hyperopic anisometropia and amblyopia after femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) combined with pleoptic treatment, and after conventional pleoptic treatment. MATERIAL AND METHODS: The first group consisted of 30 children with medium and high hyperopia, high and medium amblyopia, and anisometropia greater than 3.0 diopters, who underwent Femto-LASIK in the amblyopic eye. The second group consisted of 28 children with similar local status, who were prescribed traditional correction and received conservative treatment. The follow-up period was 1.5 years. RESULTS: After 1.5 years, higher visual acuity (p<0.05) was achieved in the first group. A significant increase in the coefficient of accommodative response (CAR) was observed in the operated amblyopic eyes in group 1 - by 0.1±0.02 c.u. compared to the control group (p<0.05). In both groups there was an upwards trend for the coefficient of microfluctuations (CMF) in the amblyopic eye, but in the first group CMF increased more significantly (p<0.05). The objective accommodative response (OAR) and positive relative accommodation (PRA) of the amblyopic eye showed a double increase - by 1.0±0.23 and 0.9±0.38 diopters, respectively, at the end of treatment in the first group. The increase in similar indicators in the second group was insignificant (p<0.05). In children of the first group the difference in ciliary muscle thickness (CMT) of the amblyopic eye with disabled and enabled accommodation increased by 0.04±0.01 mm (p<0.05) in the anterior part of the ciliary muscle at the levels of CMTmax and CMT1. CONCLUSION: The data obtained in this study indicate the strong effect of refractive laser surgery in combination with pleoptic treatment on improving the visual acuity and the state of accommodation of the amblyopic and paired dominant eyes in children with hyperopic anisometropia, in contrast to conventional methods of treatment.

Measuring aniseikonia and investigating neuroplasticity and image factors in amblyopia (MAGNIFY): study protocol for a randomised clinical trial.

BACKGROUND: Aniseikonia represents a potential barrier to neuroplasticity which may limit visual outcomes in children with anisometropic amblyopia. Full correction of refractive error is the first step in standard amblyopia treatment, which corrects for image focus but neglects image size differences. METHODS: The MAGNIFY study is a double-masked, randomised clinical trial investigating the effectiveness of aniseikonia correcting lenses in children at first diagnosis of significant anisometropia. We hypothesis that aniseikonia correction lenses will improve image clarity and reduce the retinal size differences producing better visual acuity and stereoacuity improvements after 15 weeks of optical treatment for children with anisometropia. Eligible children will be randomly allocated to the treatment group (aniseikonia-correcting spectacle lenses) or control group (standard spectacle lenses). Visual acuity and binocular functions will be assessed every 5 weeks during the 15-week optical treatment phase according to standard amblyopia treatment protocol. DISCUSSION: It is possible that correcting aniseikonia along with anisometropia at first diagnosis will promote binocularity as well as increase spectacle adherence by reducing visual discomfort, improving optical treatment outcomes. This could then reduce the need for additional amblyopia treatment such as patching or atropine, reducing the burden on hospital eye departments and potentially improving visual outcomes for children with amblyopia. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000061932 . Registered on 24 January 2020. Protocol 15th November 2019, version one.

Efficacy of supplemental Occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia.

Purpose: To study the efficacy of supplemental occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia. Methods: Thirty-one children who did not improve after partial occlusion of 6 h for 6 months were supplemented with the use of occlu-pad for 1 h per day and three such sessions in a week. Results: The mean age was 6.8+/-1.4 years (range 5-9 years). A significant improvement of 3.2+/-1.3 lines in visual acuity was noticed at the end of 3 months of starting this supplemental therapy in children. Out of 31 children, 26 children improved at least 2 lines or more at the end of 3 months. All children (n = 9) having anisohyperopic amblyopia improved at the end of 3 months. Conclusion: Occlu-pad is useful in supplementing occlusion therapy in cases of refractive amblyopia and is more effective in anisohyperopic amblyopia.

Effect of refractive error type in the amblyopic eyes on factors for treatment success in anisometropic amblyopia.

To investigate the factors for treatment success in anisometropic amblyopia according to the spherical equivalent (SE) type of amblyopic eyes. Medical records of 397 children with anisometropic amblyopia aged 3 to 12 years who presented in a secondary referral eye hospital during 2010 ~ 2016 were retrospectively reviewed. Anisometropia was defined as ≥ 1 diopter (D) difference in SE, or ≥ 1.5 D difference of cylindrical error between the eyes. According to the SE of amblyopic eyes, patients were categorized into hyperopia (SE ≥ 1D), emmetropia (- 1 < SE < + 1) and myopia (SE ≤ - 1D) groups. Treatment success was defined as achieving interocular logMAR visual acuity difference < 0.2. Multivariate logistic regression was used to analyze the factors for treatment success. Significant factors for the amblyopia treatment success in hyperopia group (n = 270) were younger age [adjusted odds ratio (aOR) (95% confidence interval, CI) = 0.529 (0.353, 0.792)], better BCVA in amblyopic eyes at presentation [aOR (95% CI) 0.004 (0, 0.096)], longer follow-up period [aOR (95%CI) = 1.098 (1.036, 1.162)], and no previous amblyopia treatment history [aOR (95% CI) 0.059 (0.010, 0.364)]. In myopia group (n = 68), younger age [aOR (95% CI) 0.440 (0.208, 0.928)] and better BCVA in amblyopic eyes [aOR (95% CI) 0.034 (0.003, 0.469)] were associated with higher odds of treatment success. There was no significant factor for treatment success in emmetropia group (n = 59) in this population. The refractive error type of amblyopic eyes at presentation affects the factors for treatment success in anisometropic amblyopia.

Effect of orthokeratology on anisometropia control: A meta-analysis.

BACKGROUND: The effectiveness of orthokeratology in retarding anisometropic progression has been investigated in several small-sample studies. This quantitative analysis aimed to elucidate the efficacy of orthokeratology for anisometropia control. METHODS: We searched PubMed, Embase, and Cochrane databases for relevant studies through September 2020. Axial length (AL) data at baseline and final follow-up were extracted, and AL elongation and difference were calculated. Methodological quality was evaluated using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. Meta-analyses were performed using a fixed-effect model based on the heterogeneity. RESULTS: A total of 10 cohort studies (nine retrospective studies; one prospective study) were included. The pooled results for the unilateral myopia group showed that the mean AL elongation difference between myopic and emmetropic eyes was -0.27 mm (95% CI, -0.31 to -0.22; p < 0.01) at the one-year follow-up (four studies) and -0.17 mm (95% CI, -0.33 to -0.02; p = 0.03) at the two-year follow-up (two studies). In the bilateral anisomyopic group, mean AL elongation difference between high and low myopic eyes was -0.06 mm (95% CI, -0.09 to -0.04; p < 0.01) at the one-year follow-up (seven studies) and -0.13 mm (95% CI, -0.21 to -0.06; p < 0.01) at the two-year followup (three studies). CONCLUSION: This study demonstrated that orthokeratology can effectively retard myopic progression and reduce anisomyopic values. However, additional wellstructured randomized controlled trials or prospective studies with longer follow-up periods are warranted to address this topic in more detail.

Fixational eye movements abnormalities and rate of visual acuity and stereoacuity improvement with part time patching.

Residual amblyopia is seen in 40% of amblyopic patients treated with part-time patching. Amblyopic patients with infantile onset strabismus or anisometropia can develop fusion maldevelopment nystagmus syndrome (FMNS). The purpose of this study was to understand the effects of presence of FMNS and clinical subtype of amblyopia on visual acuity and stereo-acuity improvement in children treated with part-time patching. Forty amblyopic children who had fixation eye movement recordings and at least 12 months of follow-up after initiating part-time patching were included. We classified amblyopic subjects per the fixational eye movements characteristics into those without any nystagmus, those with FMNS and patients with nystagmus without any structural anomalies that do not meet the criteria of FMNS or idiopathic infantile nystagmus. We also classified the patients per the clinical type of amblyopia. Patching was continued until amblyopia was resolved or no visual acuity improvement was noted at two consecutive visits. Children with anisometropic amblyopia and without FMNS have a faster improvement and plateaued sooner. Regression was only seen in patients with strabismic/mixed amblyopia particularly those with FMNS. Patients with FMNS had improvement in visual acuity but poor stereopsis with part-time patching and required longer duration of treatment.

A comparative study of orthokeratology and low-dose atropine for the treatment of anisomyopia in children.

Myopic anisometropia (anisomyopia) is a specific type of refractive error that may cause fusion impairment, asthenopia, and aniseikonia. It is sometimes severe enough to reduce the quality of life. Several studies have investigated the treatment effects of orthokeratology (Ortho-K) and topical atropine on anisomyopia control. However, no study has compared these two interventions simultaneously until now. The cohort of this retrospective study included 124 children with anisomyopia who were treated with binocular Ortho-K lenses, 0.01% atropine, or 0.05% atropine. After a 2-year follow-up, the inter-eye difference in axial length (AL) significantly decreased in the Ortho-K group (P = 0.015) and remained stable in the two atropine groups. When comparing the myopia control effect, the use of Ortho-K lenses resulted in an obviously smaller change in AL than the use of 0.01% and 0.05% atropine (P < 0.01). Ortho-K treatment may reduce the degree of anisomyopia and stabilise the progression of myopia. Hence, Ortho-K might be a better choice for anisomyopic children.

Clinical observations of the effect of orthokeratology in children with myopic anisometropia.

PURPOSE: To evaluate the clinical effect of orthokeratology in controlling myopia and treating anisometropia among children with myopic anisometropia. METHODS: A total of 108 myopic anisometropic children aged 8-16 years old who wore orthokeratology lenses in both eyes were enrolled in this study and followed up for over 1 year. The more severely myopic eye of each patient was assigned to the more myopic group (108 eyes), with a mean spherical equivalent refraction of -4.25 (-5.00, -3.38) D; the opposite eye of each patient was assigned to the less myopic group (108 eyes), with a refraction of -2.75 (-3.63, -1.88) D. This study observed and analyzed changes in ocular parameters after orthokeratology (Wilcoxon signed-rank test). RESULTS: In children who wore orthokeratology lenses for approximately 1 year, the level of anisometropia significantly dropped from 1.38 (1.13, 1.75) D to 1.25 (1.13, 1.75) D (P = .005). The difference between the axial lengths of the two eyes significantly dropped from 0.54 (0.37, 0.74) mm to 0.46 (0.28, 0.67) mm (P< .0001). CONCLUSIONS: Orthokeratology seemed to be more effective at delaying the progression of myopia in the more myopic eyes than in the less myopic eyes of myopic anisometropic children. Orthokeratology lenses are suitable for anisometropic children, although the effectiveness of orthokeratology against anisometropia requires additional follow-up time for further observation and study.

Effects of simulated anisometropia and aniseikonia on stereopsis.

PURPOSE: Stereopsis depends on horizontally disparate retinal images but otherwise concordance between eyes. Here we investigate the effect of spherical and meridional simulated anisometropia and aniseikonia on stereopsis thresholds. The aims were to determine effects of meridian, magnitude and the relative effects of the two conditions. METHODS: Ten participants with normal binocular vision viewed McGill modified random dot stereograms through synchronised shutter glasses. Stereoacuities were determined using a four-alternative forced-choice procedure. To induce anisometropia, trial lenses of varying power and axes were placed in front of right eyes. Seventeen combinations were used: zero (no lens) and both positive and negative, 1 and 2 D powers, at 45, 90 and 180 axes; spherical lenses were also tested. To induce aniseikonia 17 magnification power and axis combinations were used. This included zero (no lens), and 3%, 6%, 9% and 12% at axes 45, 90 and 180; overall magnifications were also tested. RESULTS: For induced anisometropia, stereopsis loss increased as cylindrical axis rotated from 180° to 90°, at which the loss was similar to that for spherical blur. For example, for 2 D meridional anisometropia threshold increased from 1.53 log sec arc (i.e. 34 sec arc) for x 180 to 1.89 log sec arc (78 sec arc) for x 90. Anisometropia induced with either positive or negative lenses had similar detrimental effects on stereopsis. Unlike anisometropia, the stereopsis loss with induced meridional aniseikonia was not affected by axis and was about 64% of that for overall aniseikonia of the same amount. Approximately, each 1 D of induced anisometropia had the same effect on threshold as did each 6% of induced aniseikonia. CONCLUSION: The axes of meridional anisometropia but not aniseikonia affected stereopsis. This suggests differences in the way that monocular blur (anisometropia) and interocular shape differences (aniseikonia) are processed during the production of stereopsis.

Binocular treatment in adult amblyopia is based on parvocellular or magnocellular pathway.

INTRODUCTION: Amblyopia is speculated to be an untreatable disease in the patient, who is beyond the critical period of vision; however, currently, it is treatable in adults. PURPOSE: This study aimed to elucidate whether the treatment is useful in both anisometropic amblyopia and strabismic amblyopia. In addition, the differences were detected between anisometropic amblyopia and strabismic amblyopia after the same perceptual treatment and whether the suppression in anisometropic amblyopia or strabismic amblyopia could be decreased before and after the treatment. METHODS: A binocular perceptual learning was applied for the treatment, the suppression was measured, and the patients were followed up for 2 months after training. Anisometropic amblyopia and strabismic amblyopia groups were subjected to the assessment of stereo, visual acuity, contrast sensitivity, and suppression before and after the training. RESULTS: After 6 weeks of "Diploma Gabor Orientation Coherence" training, in the anisometropic amblyopia group, the outcomes of visual acuity (t = 3.114, p = 0.026) and contrast sensitivity (t = 7.786, p = 0.001) were increased significantly. While in the strabismic amblyopia group, the outcomes of stereo (t = 2.987, p = 0.040) and contrast sensitivity (t = 3.638, p = 0.022) were increased significantly. CONCLUSION: After Diploma Gabor Orientation Coherence training in the same frequency and in the same duration, the anisometropic amblyopia group got an improvement in visual acuity, but the strabismic amblyopia group got an improvement in stereo. As there are evidences to show that anisometropic amblyopia and strabismic amblyopia were injured in different pathways, we think the diverse results might come from the different pathway injury in anisometropic amblyopia and strabismic amblyopia.

Orthokeratology lens for management of myopia in anisometropic children: A contralateral study.

PURPOSE: To investigate the effect of overnight orthokeratology (OK) lens wear on axial growth in anisometropic children. METHODS: The study involved 17 males and 12 females with an average age of 11.4 ± 2.9 years. Cycloplegic spherical equivalent error (SER) was -0.50D to -6.00D, and anisometropia ≥1.00D. The eyes with greater myopia were assigned to the G eye group and the fellow eyes with less myopia to the L eye group. All eyes were fitted with OK lenses. Axial length (AL) was measured at the beginning of the study and at 6-, 12-, 18-, and 24-month follow-up visits. Refractive error was measured at the beginning and at the 24-month visit. Linear mixed model analysis was used to evaluate the effect of time, group, and time*group on axial growth. Paired t test was used to compare the myopia increase over 24 months between the two groups. RESULTS: The mean baseline AL was 25.06 ± 0.61 mm for the G eyes and 24.48 ± 0.61 mm for the L eyes. After 24 months, AL had increased by 0.31 ± 0.23 mm in the G eye group and by 0.41 ± 0.31 mm in the L eye group. Axial growth of the L eyes was significantly greater than that of the G eyes (p = 0.006). The mean baseline myopia of the G eye and the L eye was -3.62 ± 1.27D [-5.75D to -1.75D] and -1.93 ± 1.02D [-4.00D to -0.50D] respectively. At 24 months, the increase in myopia in the G eyes was significantly less than that in the L eyes (-0.84 ± 0.63D vs, -1.21 ± 0.89D, p < 0.001). CONCLUSIONS: In anisometropic children who wore OK lenses, axial growth was greater in the eye with less baseline myopia than in the fellow eye with greater baseline myopia after 2 years.

Pattern of Axial Length Growth in Children Myopic Anisometropes with Orthokeratology Treatment.

PURPOSE: To compare the pattern of growth in axial length (AL) between children with anisometropia who wear orthokeratology (OK) lenses and those who wear spectacles (SP). METHODS: A retrospective study was conducted. Data of baseline and 1 year from 252 children (8-14 years old) anisomyopes who sought refraction corrections at the Zhongshan Ophthalmic Center between October 2013 and June 2017 were reviewed. Seventy-nine unilateral myopic anisometropes (UMA) and 98 bilateral myopic anisometropes (BMA) treated with OK lenses were set as study groups (OK-UMA and OK-BMA groups). Age, refraction, and AL-matched unilateral (n = 38) and bilateral myopic anisometropes (n = 37) treated with spectacles were set as control groups (SP-UMA and SP-BMA groups). The 1-year change in AL between the study and control groups (OK-UMA vs. SP-UMA and OK-BMA vs. SP-BMA) was compared. RESULTS: There were no significant differences in the baseline of age, refraction, and AL between OK-UMA and SP-UMA or OK-BMA and SP-BMA groups (all P > .05). Compared to the SP-UMA group, annual axial elongation of the myopic eyes of the OK-UMA group was smaller (0.05 ± 0.19 mm vs. 0.33 ± 0.29 mm, P < .001); however, AL elongation in the non-myopic eyes were comparable between SP-UMA and OK-UMA groups (P > .05). At the end of 1 year, the interocular difference in AL (aniso-AL) decreased by 0.29 ± 0.29 mm (P < .001) in the OK-UMA group but remained unchanged in SP-UMA group. Compared to the SP-BMA group, annual axial elongations of both eyes of the OK-BMA group were smaller (the more myopic eye, 0.05 ± 0.17 mm vs. 0.38 ± 0.21 mm; the less myopic eye, 0.15 ± 0.19 mm vs. 0.35 ± 0.28 mm; both P < .001). At the end of 1 year, aniso-AL decreased by 0.10 ± 0.15 mm (P < .001) in the OK-BMA group but remained unchanged in the SP-BMA group. CONCLUSION: Orthokeratology is effective in reducing the interocular difference in AL of children anisomyopes through greater retardation of axial elongation of the more myopic eyes.

Effects of orthokeratology lens on axial length elongation in unilateral myopia and bilateral myopia with anisometropia children.

PURPOSE: To investigate the effect of orthokeratology (OK) lens on axial length (AL) elongation in unilateral myopia and bilateral myopia with anisometropia children. METHODS: Twenty-seven unilateral myopia (group 1) and 25 bilateral myopia with anisometropia children (group 2) were involved in this 1-year retrospective study. The eyes with higher spherical equivalent refractive error (SER) were assigned to the H eyes subgroup and the fellow eyes with lower SER to the L eyes subgroup in the two groups. RESULTS: The mean change in AL of H eyes and L eyes were 0.11 ± 0.19 mm, 0.30 ± 0.28 mm in group 1 (P = 0.04) and 0.09± 0.14mm, 0.13± 0.16mm in group 2 (P = 0.36), respectively. Multivariate regression analyses showed that significant difference of change in AL was found between H eyes and L eyes in group1 (ß=0.25, P = 0.03), but no difference in group 2 (ß=0.09, P = 0.12). The AL of H eyes in group 1 and group 2, H eyes in group 1 and L eyes in group 2 had the same increased rate (ß= -0.04, P = 0.43; ß = 0.02, P = 0.56). CONCLUSIONS: Monocular OK lens is effective on suppression AL elongation of the myopic eyes and reduce anisometropia value in unilateral myopic children. The OK lens can control the AL elongation in both eyes at the same rate, but it cannot reduce anisometropia value in bilateral myopia with anisometropia children after 1-year follow-up.

Changes in aniseikonia of an axial anisometrope at various stages of orthokeratology lens wear.

PURPOSE: To report a case of reduced aniseikonia in a myopic axial anisometrope during orthokeratology (OK) lens wear. CASE REPORT: A 19-year-old female university student with myopic anisometropia presented for an OK lens fitting consultation. At baseline, perceptual interocular image size difference or aniseikonia of 1.45% was found, with a smaller image seen by the right eye compared to the left eye. The patient was fitted with a pair of OK lenses and interocular image size differences, subjective refraction and corneal topography were measured after 7, 14 and 47 days of overnight lens wear. Hyperopic shifts in central refraction and corresponding flattening of the central cornea was measured during OK treatment. Aniseikonia reduced after OK wear with the most significant change measured from baseline to day 7. Aniseikonia recorded after 7, 14 and 47 nights of lens wear was 0.05%, 0.35% and 0.85%, respectively. Although minimum differences in refractive error between eyes was reached after 47 days of OK, aniseikonia was greater than that measured after 7 and 14 days of OK. CONCLUSION: This case report demonstrates reduction in aniseikonia with OK lens wear in a myopic patient with axial anisometropia, although this effect was not sustained beyond 1 week of lens wear. As the impact of corneal curvature changes on aniseikonia is not well understood, future studies on the impact of OK on aniseikonia and associated asthenopia is required.

Anisometropia and isoametropia associated with microstrabismus: effectiveness of late anti-amblyopia treatment.

PURPOSE: Outcomes Research Study on patients suffering from anisometropia or isoametropia associated with amblyopia and microstrabismus to show the impact of late occlusion treatment on therapeutic prognosis. MATERIALS AND METHODS: Enrollment of all the eligible patients presenting to recruiting centers at the Department of Pediatric Ophthalmology and Strabismus - Ophthalmological Clinic - Policlinico Umberto I - Rome. At baseline, all patients will undergo an opthalmologic evaluation. Recruited patients will be followed for a 2-year period. Our test group was composed of 31 patients, 11 with bilateral and 20 with monolateral amblyopia, totalling 42 amblyopic eyes, and it was assessed - always by the same examiner - with the help of the following orthoptic examinations: Wirt test, Irvine-Jampolsky test (4 dioptre fixation task), Visuscope, Cover Test, Bagolini striated glasses, and Worth lights test. We assessed pre-post treatment variations observed in the overall group of amblyopic eyes, regardless of the differences between RE and LE. OUTCOMES: Of the 31 children, 58.1% were males and 41.9% female, average age between 6 and 14 years. Of the 42 amblyopic eyes, after daily occlusion of 8 hours ± 2.30 SD, we recorded an improvement of 71.4%, and visual acuity increased from an average of 0.4 LogMAR to 0.1 LogMAR. CONCLUSION: Late anti-amblyopic occlusion treatment proved effective in the long term for children 6 to 12 years, specifically regarding visual acuity, fixation, stereopsis, and binocular collaboration in patients suffering from anisometropia or isoametropia and microstrabismus.

Tratamento da aniseiconia induzida na correção óptica de anisometropia em escolares do ensino fundamental / Treatment of aniseikonia induced by optical correction of anisometropia in elementary school children

Resumo Objetivos: Comparar a aniseiconia e a estereopsia em escolares anisometropes do primeiro ano do ensino fundamental corrigidos com lentes oftálmicas de estoque com curvas-base selecionadas para minimizar a diferença de tamanho interocular das imagens retínicas e com lentes iseicônicas sugeridas pelo software Aniseikonia Inspector 3 e verificar a preferência dos escolares por uma destas formas de correção. Métodos: Dezenove escolares com anisometropia ≥ 1,5 D em meridianos correspondentes no uso de óculos com lentes oftálmicas de estoque e com lentes iseicônicas foram avaliados para aniseiconia (software Aniseikonia Inspector 3) e estereopsia (teste Stereo Fly test com símbolos LEA. A preferência por uma das formas de correção foi verificada após 40-50 dias de uso dos óculos. Resultados: As médias e os desvios-padrão das aniseiconias vertical e horizontal no uso de óculos com lentes oftálmicas de estoque e com lentes iseicônicas foram, respectivamente, -1,05% ± 2,20% e -1,37% ± 2,36% (p=0,82739) e -0,895% ± 2,23% e -1,16% ± 2,03% (p=0,77018). 31,6% dos escolares corrigidos com lentes iseicônicas e 21,1% dos escolares corrigidos com lentes oftálmicas de estoque identificaram os optotipos que sugerem estereopsia < 100 segundos de arco (p= 0,475). Em relação à preferência, 4/15 (26,7%) escolheram os óculos com lentes iseicônicas, 2/15 (13,3%) escolheram os óculos com lentes oftálmicas de estoque e para 9/15 (60%) a escolha foi indiferente. Conclusão: A aniseiconia induzida nos escolares anisometropes corrigidos com lentes iseicônicas sugeridas pelo software Aniseikonia Inspector 3 foi similar ao obtido na correção com lentes oftálmicas de estoque com curvas-base selecionadas para minimizar a diferença de tamanho interocular das imagens retínicas.

Abstract Objectives: To compare the aniseikonia and the stereopsis in school children anisometropes of the first-year of elementary school corrected with stock ophthalmic lenses with base curve selected to minimize the interocular size difference of retinal images and with size lenses suggested by the software Aniseikonia Inspector 3, and to check the preference of them for one of these forms of correction. Methods: Nineteen school children with anisometropia ≥ 1.5 D in corresponding meridians, in the use of glasses with stock ophthalmic lenses and with size lenses were evaluated for aniseikonia (software Aniseikonia Inspector 3) and stereopsis (Stereo Fly test with LEA symbols). The preference for one of the forms of correction was verified after 40-50 days of wearing glasses. Results: The mean and standard deviations of the vertical and horizontal aniseikonia in the use of glasses with stock ophthalmic lenses and with size lenses were, respectively, -1.05% ± 2.20% and-1.37% ± 2.36% (p = 0,82739) and -0.895% ± 2.23% and -1.16% ± 2.03% (p = 0,77018). 31.6% of the school children corrected with size lenses and 21.1% of the students corrected with stock ophthalmic lenses identified the optotypes that suggest stereopsis less than 100 seconds of arc (p = 0.475). Regarding the preference, 4/15 (26.7%) of the students chose the glasses with size lenses, 2/15 (13.3%) chose the glasses with stock ophthalmic lenses, and for 9/15 (60%) the choice was indifferent. Conclusion: The induced aniseikonia in school children with anisometropia corrected with size lenses suggested by the software Aniseikonia Inspector 3 was similar to that obtained in the correction with stock ophthalmic lenses with base curves selected to minimize the difference of interocular size of retinal images.

The effect of asymmetrical accommodation on anisometropic amblyopia treatment outcomes.

BACKGROUND: Previous research has revealed that the majority of children with anisometropic amblyopia have asymmetrical accommodation. The aim of this preliminary study was to determine whether the type of accommodation response was associated with a poor amblyopia treatment outcome in the same patients. METHODS: The type of accommodation response of 26 children with anisometropic amblyopia was determined in a previous study. The final visual acuity in the amblyopic eye, after treatment, was compared between those with symmetrical, aniso-, and anti-accommodation. RESULTS: The difference in final visual acuity between the three accommodation groups was significant (P = 0.023). Subjects with anisometropic amblyopia with anti-accommodation had the poorest final visual acuity (0.42 ± 0.25 logMAR) with a statistically significant difference compared with those who had aniso-accommodation (0.14 ± 0.08 logMAR; P = 0.023). However, the difference failed to reach significance compared to those with symmetrical accommodation (0.20 ± 0.12 logMAR; P = 0.234), probably due to the small sample size. The initial visual acuity in the amblyopic eye and the degree of anisometropia were also significantly positively correlated with final visual acuity (P < 0.001 for both). CONCLUSIONS: In this study cohort, the presence of anti-accommodation in anisometropic amblyopia was associated with a poorer amblyopia treatment outcome. The initial visual acuity in the amblyopic eye and the degree of anisometropia were also associated with a poorer outcome. It is possible that all these factors are associated, but further research is required to determine causal relationships.